Provider Demographics
NPI:1447207642
Name:COLINCO, MAELYNN D (MD)
Entity Type:Individual
Prefix:
First Name:MAELYNN
Middle Name:D
Last Name:COLINCO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4555 WEST SCHROEDER DRIVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-3225
Practice Address - Street 1:7007 NORTH RANGE LINE ROAD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209
Practice Address - Country:US
Practice Address - Phone:414-352-3341
Practice Address - Fax:414-247-4588
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI34964207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32252800Medicaid
G43824Medicare UPIN
WI32252800Medicaid
WI000104018Medicare PIN
WI000146385Medicare PIN